Healthcare Provider Details

I. General information

NPI: 1730669953
Provider Name (Legal Business Name): STEPHANIE ELLEN KINTZING APN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 FRANKLIN AVE STE 5
FRANKLIN LAKES NJ
07417-1418
US

IV. Provider business mailing address

105 HAWTHORNE AVE APT E
PARK RIDGE NJ
07656-3207
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-8811
  • Fax:
Mailing address:
  • Phone: 201-994-9341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00849100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: